Professional Documents
Culture Documents
Prevalence
Prevalence
BY
ORSAR D. O. UJ/2007/MD/0319
AGUBE V. G. UJ/2007/MD/0320
HARUNA F. A. UJ/2007/MD/0321
JUNE, 2015.
DECLARATION
We hereby declare that this is our original work done under appropriate
supervision that it has not been presented in part in whole for another
2
CERTIFICATION
I certify that I supervised this work and it has fulfilled the minimum
…..……………………… ………………………………
(Supervisor)
………………………………. ……………………………
Head of Department,
Community Medicine,
University of Jos.
3
DEDICATION
We dedicate this work to God Almighty who made it possible for us to carry out
this project. It was His strength and grace that made this possible.
4
ACKNOWLDGMENT
This work has been carried out to a successful completion because we rode on
the shoulders of those who went ahead of us, whose contribution in no small
We express our profound gratitude to God Almighty for making this work a
reality.
Our appreciation also goes to our supervisor Dr. D.A Bello, whose constant
input and guidance made the work a lot easier for us. We also acknowledge the
Chirdan.
Our thanks go to our lovely parents for their support and provision towards the
success of our project, Mr. and Mrs. M. Orsar, Mr. and Mrs Agube and Mr. and
Mrs. Haruna.
We are grateful to the medical students of University of Jos for their efforts in
Indeed we are grateful to you all for making this work a great success.
5
TABLE OF CONTENTS
Title page………………………………………………………………………1
Declaration……………………………………………………………………..2
Certification…………………………………………………………………....3
Dedication…………………………………………………………….………..4
Acknowledgment ……………………………………………….………….…. 5
Table of contents………………………………………………….…….………6
Abstract ………………………………………………………………………. 11
Chapter one
1.1Background ……………………………………………………………… 12
6
1.3 Rationale of study ………………………………………………………. 15
Chapter two
Chapter three
7
3.3 Study design ………………………………………………………………
3.9Limitation ………………………………………………………………..
Chapter four
8
4.3.3 Sexual abuse ………………………………………………………………
Chapter five
Chapter six
9
6.2 Recommendation ………………………………………………….
References ………………………………………………………………….
Appendix …………………………………………………………………
10
List of tables
11
LIST OF ABBREVIATIONS
12
ABSTRACT
BACKGROUND
half of the world population will develop one form of depression or the other.
As medical students are a part of the global society, they are not exempted as
they are daily exposed to academic, psychosocial and health related events
which predisposed them to depression. This study was carried out to ascertain
administered questionnaire was used to assess two hundred and seventy five
RESULTS: The mean age of respondents was 25+5 years. The prevalence of
13
CONCLUSIONS: The prevalence of depression among medical students in
University of Jos is low. This because most of the factors that predispose to
It was recommended that students who are depressed should visit the University
clinic for appropriate intervention and the University should put in place
14
CHAPTER ONE
1.0 INTRODUCTION
practice but is often undetected. The central features of depression are low
low mood, lack of energy and enjoyment, and poor sleep. Mood may vary
during the day; usually it is worse in the evening than in the morning in contrast
moderate severity; central features are low mood, lack of enjoyment, reduced
energy and pessimistic thinking. Restlessness and slowing down of mental and
motor activities and depressed individuals show no enthusiasm for activities and
hobbies that they will normally enjoy accompanied by reduced energy, poor
15
concentration and complaint of poor memory. They may have some depressive
thinking like seeing the unhappy side of every event, always expecting the
worst and unreasonable guilt about trivial events of the past. Some biological
symptoms include early morning waking where depressed individuals wake two
to three hours before their usual time, find it difficult to fall asleep and wake at
night and there may be associated loss of appetite and weight loss.2
In severe depression, the moderate symptoms occur with greater intensity with
other disorders like delusions and hallucinations. The delusions take the form of
worthlessness, guilt, ill health and poverty. The hallucinations may take the
ages between twenty to fifty years, low self-esteem, excessive weight, alcohol
use, tobacco use, physical illnesses like diabetes, cancer and heart disease and
contributor to the global burden of disease. About 350 million people of all ages
16
(WHO).3 A study conducted in 2008 by the WHO, World Mental Health Survey
episode of depression in the previous year.3In its most serious form, depression
leads to a forestalling of human potential. 3 There are more than 800,000 suicide
per year, according to the WHO’s first global report on suicide prevention. 3The
WHO has estimated that depression has higher burden than lung, colorectal,
breast and prostate cancers combined, and more than other psychiatric
place is a leading cause of loss of work productivity, due to, for example, sick
In most countries the proportion of people who suffer from depression during
their lives can be as low as 8% and as high as 17% with an average of 12% 5,
1.3RATIONALE OF STUDY
Depression is a prevalent and widespread problem and like in any other society,
17
part.8 This group of students are going through a new and challenging phase in
academic work, planning for the future and being away from home and all these
serve as stressors to the students.9As a reaction to this stress, some students skip
classes and isolate themselves without realising they are depressed. Previous
extension is noted around the world and the prevalence seems to be increasing. 10
particularly salient problem for medical student population because over two-
third of young people do not talk about or seek help for mental health problem. 11
University of Jos are few and since studies have shown that 17% of the general
students in University of Jos will have depression and this over the years
probably have been responsible for the poor performance seen among some
medical students.
missed cases of depression and identify medical students in the early course of
18
depression and appropriate recommendations made to the faculty of medicine,
University of Jos.
University of Jos.
University of Jos
in University of Jos.
19
CHAPTER TWO
2.1 INTRODUCTION
The cause of depression is yet to be known however, there are risk factors that
are associated with depression. These are; family history of mood disorders,
female gender, women who are unhappily married, separated or divorce, ages
between twenty and sixty, low self-esteem, excessive weight gain, alcohol use,
tobacco use, and physical illnesses like diabetes mellitus, cancer and heart
disease. The risk factors that are commonly found among medical students are;
older age, low socioeconomic status, role in choice of medical career, negative
relationship issues.12,13
20
2.2 PREVALENCE OF DEPRESSION
symptoms. It was found out that 23.3% of the students were depressed which
showed study that a quarter of the students had one form of depressive symptom
or the other.14
Western Nigeria in 2006. It was found out that 8.3% of the students were
depressed. It was recommended for an effective model for the prediction of the
associated factors and found that 7.0% of the students had severe depression
and 25.2% with moderate depression. It was recommended that factors that are
21
In a cross-sectional study conducted among 550 students in three private
the respondents ranged from 11.45% to 35.81%. It was also found that females
were more depressed (37.30%) than males (34.64%). It was recommended that
found to be 39.2%. This study was conducted in a single University and also
was found to be 35.7% for moderate and 5.6% for major depressive symptoms.
be inaccurate. Also, the study was conducted in one University and there could
be regional differences in other local Universities therefore the need for further
research.19
22
psychological stress and was found to be 33.6% which showed that more than a
quarter of the students had one form of depressive symptom or the other.20
depression and was found that 60% of the students were depressed. This finding
is consistent with other western studies. However, there are no local data to
of Calabar to determine the prevalence of stress and stressors and found that the
Pakistan, it was found that those living in University dormitories were more
depressed than those living at home. Those having a history of negative life
23
pressure, mental tension and too much workload are the most common
predisposing factors for depression. It was also found out that females express
more symptoms. 24
Pakistan, and it was found out that substance abuse, having family history of
depression and anxiety and loss of a relative in the last one year are the most
first and third MBBS of B.P. Koirola institute of Health Sciences Nepal. It was
found out that apart from academic stress and hectic lifestyle were the main
inducing factor for depression. The study included only first and third year
students in the sample. Also, only the well-studied principal stressors were
From previously sited literature it was found out that depressive symptoms was
significantly more among the first year students, those who were married; those
who were economically disadvantaged, those living off campus, those using
tobacco, those that drink alcohol and those with older age.19
24
In a cross-sectional study conducted among 762 medical students in University
of Nigeria Enugu to determine the various coping strategies and found out that
determine the differences in perceived stress and its correlates and found that
students used psychosocial support in the form of talking to friends, parents and
relatives and similar findings were reported by other studies. This study was
done in one campus; therefore caution should be taking not to generalize the
result.28
Saudi Arabia. The coping strategies identified were: respecting ones limit,
predisposing factors are smoking and alcohol consumption, while others are
25
academic challenge, ill health, and loss of love one. Most students cope by
CHAPTER THREE
The study will be conducted in the department of medicine and surgery of the
sciences, as well as arts and humanities. The University was first established in
The university has three (3) campuses; the main campus which is located along
permanent site of the University is located along Farin Gadaroad; it houses the
26
The third campus which is referred to as the old campus because it is the first
Medical sciences.30
medical students. The pre-clinical departments and its central administration are
located at the Bauchi road campus of the University. While the clinical
departments and posting for the medical students take place at the Jos
University Teaching Hospital (JUTH), which is located along Shere hills, Jos
The study population will consist of medical students from across all the six (6)
levels.
27
The sample size for the study will be calculated using the formula for cross
n=Z2pq
d2
Where;
=0.767
d= Absolute Precision
=0.05
Thus;
28
(0.05)2
= 0.687
0.0025
=275
Therefore the minimum sample size for the study will be 275. For non-
responses, 10% of this number will be added that is 28. This will give a
STAGE 1;
Total number of students in each level will be obtained and the proportion of
This will give the proportion of students to be used for each level. For example
for the 500level class with a population of 142, the proportion to be used will
be;
29
142/1000 × 275 =39
STAGE 2;
The proportion of students to be selected from each level that will participate in
For example to select thirty – nine, 39 participants from 500 level, 39 yes and
103 no will be place in a box, students who pick the yes will be use for the
study.
study.
The first section (section A) will consist of questions concerning the socio-
demographic data. It will include questions on age, gender, level, ethnic group,
Religion, family size, are both parent alive, are both parent living together,
parents’ occupation.
The second section (section B) will consist of the Beck’s depression inventory
severally and tested and has content validity and face validity.31
The third section (section C) will consist of questions that will be use to assess
Jos.
The fourth section (section D) will consist of questions that will assess the
Data obtained from this study will be collated and analysed using Epi info
statistical version 3.5.4. Quantitative data such as age will be presented in mean
and standard deviation. Qualitative data such as sex will be presented using
frequency tables. Chi square test will be used to establish statistical relationship.
95% confidence interval will be used for the study and P value of <0.05 will be
The highest possible total score for the whole test is 63 while the lowest
31
1-10____________________These ups and downs are considered normal
21-30___________________Moderate depression
31-40___________________Severe depression
3. 8 ETHICAL CONSIDERATIONS
Approval for the conduct of the study will be obtain from the head of
within the university and letter of introduction will be given by the department.
The nature, aims and objective of the study will be explained to each student
informed consent will be obtained from each student. Students who are likely to
32
3.9 LIMITATION
In providing some of the information, the participants may have to rely on their
memory to identify what in the past might have cause their illness, as the human
CHAPTER FOUR
4.0 RESULTS
The study was carried out among medical students in university of Jos, between
April and May 2015. A total of 275 questionnaires were distributed and 275
RESPONDENT
The age group of 20-24 years constituted the highest respondents. The mean age
the respondent was 25 years. Most of the respondents 172(62.5%) were male.
Most of the respondents 264(96.6%) are single, while the rest 11(4.0%) are
their parents. Most of the respondents 129(46.6%) earn more than N10, 000.
(Table 1)
33
Table 1. Sociodemographic characteristics of respondents
15-19 5 1.8
30-34 17 6.2
SEX
TRIBE
Hausa 3 1.1
Igbo 50 18.2
34
Yoruba 20 7.3
RELIGION
Islam 15 5.5
LEVEL
200 54 19.7
300 61 22.3
400 48 17.5
500 46 16.8
600 66 24.0
MARITAL STATUS
married 11 4.0
Extended 80 29.3
35
SOURCE OF INCOME
friends 4 1.5
husband 1 0.4
relatives 10 3.6
self-employ 6 2.2
Others 11 4.0
>70,000 10 3.6
31,000-50,000 13 4.7
51,000-70,000 3 1.1
Most of the respondents are normal, 237(86.1%). The rest have varying degrees
36
of depressions such as mild mood disturbance, borderline clinical depression,
11-16 30 10.9
17-20 1 0.4
21-30 4 1.5
31-40 2 0.7
>40 1 0.4
4.3.1. Bereavement
37
Most of the respondents, 9.7% who have loss someone close to them have mild
mood disturbance. Only 0.7% respondent who have extreme depression have
someone (P>0.05)
X2 =3.04;df=5;p=0.6942
38
Only 30.8% of the respondents who have mild mood disturbance did not enjoy
X2=5.79;df=5;p=0.3277
39
4.3.3 Sexual abuse
Only 20.0% of the respondents who have mild mood disorder were sexually
abuse. (p>0.05))
X2=1.71;df=5;p=0.8881
40
4.3.4 Smoking
Most of the respondents 46.2% who smoke have mild mood disturbance. Only
7.7% respondent who has moderate depression smokes while 1.2% respondents
X2=21.59;df=5;p=0.0006
41
4.3.5 Alcohol
Majority of respondents, 19.1% who are depressed take alcohol and have mild
mood disturbance. Only 4.3% of the respondents who take alcohol have severe
depression. (Table 7)
intake. (p<0.05)
X2=17.85;df=5;p=0.0031
42
4.3.6 Academic stress
Most of the respondents, 17.2% who are depressed have academic challenges
and have mild mood disturbance. Only 1.1% respondent with severe depression
Having too much work load was identified as the predominant academic
depression. (p<0.05)
43
Table 8; Relationship between academic Challenge and depression
X2=19.90;df=5;p=0.0013
Other 4 4.4
Total 90 100.0
44
4.3.7 Weight
Most of the respondents 14.6% who are depressed feel uncomfortable with their
weight and have mild mood disorder. Only 2.4% of the respondent who feel
(P>0.05)
X2=7.50;df=5;p=0.1863
45
4.3.8 ill Health
Most of the respondents, 26.9% with mild mood disturbance have some form of
ill health. Only 3.8% respondents with severe depression have ill health. (Table
10)
X2=23.43;df=5;p=0.0003
46
4.4 Coping Mechanism
47
CHAPTER FIVE
5.0 DISCUSSION
A total of two hundred and seventy-five questionnaires were distributed and two
Those respondents of age 20-24 years (47.3%) constituted the highest age while
those of age 15-19(1.8%) constituted the lowest group of respondents. The age
range of the students was 15-34 years, which is similar with the age range of a
Nigeria, Enugu which is 16-30 years. 23 This is also the age range of the medical
Most of the respondents are male, 62.5%. This higher proportion of male
compared to females can be attributed to the fact that in our environment more
value is placed on the education of the male child against the girl child
Obafemi Awolowo University in Nigeria, where it was found out that 54.3% of
the respondents where male while 45.7% of the respondents are female.
both males and females, the proportion of females in school was equal to or
48
to determine the prevalence of depression, anxiety and their associated factors.
It was found out that 58.8% of respondents are female while 41.5% of the
Most of the respondents are Christians, 94.5% while 5.5% are Islam. This
higher proportion of Christians can be attributed to the fact that religion still
Most of the respondents are single, 96.0% while only 4.0% are married. This
associated factors. It was found that 93.7% of the respondents are single while
Most, 70.7% are from a nuclear family setting while 29.3% are from extended
49
associated factors. Is was found that 73.0% of the respondents live in a nuclear
family setting while, 27.0% live in an extended family setting. African families
are often times considered to be extended in nature; however this study shows
that most respondents are from the nuclear family setting. The reason for this
pattern and also the rising cost of living which makes it difficult to sustain large
families.
50
the prevalence of depression among the medical students was found to be
57.9%.30
The result obtained from the study is also not in keeping with the prevalence of
The low prevalence of depression in this study (13.8%), may be due to the
recent years. Another reason may be the sample size difference (275 vs. 189 and
The factors that predispose to depression from the study are smoking, alcohol
consumption, academic challenge and health challenge. Other factors that could
51
childhood experience, sexual child abuse and weight. These findings are similar
factors that predispose to depression are academic stress and hectic lifestyle. 22
These show that smoking, alcohol consumption and academic challenge are
Stress has been found to correlate with depression. 20 Previous studies have
physical illness, emotional problems and worries about the future, contribute to
From this study, 13.8% of the respondents were found to be depressed, of this
13.2% cope by watching a movie, 21.1% cope by praying ,2.6% cope by crying,
52
2.6% cope by taking sleeping pills and 31.6% cope by smoking or by alcohol
consumption.
University of Nigeria, Enugu. The study showed that 66% cope by talking to
Compared to this study, fewer students from the study conducted cope by
consumption.
College, Raichur, Karnataka, it was found out that most students cope by
talking to someone.24
Different individuals use different strategies for coping with negative affective
state and associated life problems. Strategies are developed to identify means to
the individual’s personality, life experience, faith and the nature of loss.
53
CHAPTER SIX
6.1 CONCLUSION
It was concluded from this study that 13.8% of medical students in university of
Jos have varying forms of depression. The factors that predispose to depression
among the students were found to include academic challenge, health challenge,
6.2 RECOMMENDATIONS
1. Students who are found to be depressed should visit the university school clinic
for appropriate intervention and where necessary they should be referred to see
2. The University of Jos should put in place modalities for periodic screening of
students so those students who are tending towards depression are identified
3. The University of Jos authorities should carry out studies on other students in
54
REFERENCES
Availableat:http://www.euro.who.int/en/health-topics/noncommunicable-
disease/pages/news/2012/10/depression-in-europe/depression-
definition.Accessed 10.10.2015
http://www.who.int/mediacentre/events/annual/world_suicide_prevention_day/
en/Accessed 13.01.2015
at:http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004upd
(NCSR).JAMA.2003;289(203):3095-3105
2012;140(3):205-214
55
8. Iidar EA, koushi MF, Mazloum S, Navidian A. Prevalence of depression among
Sciences.2004;6(2):15-29
Anxiety.2006;23(4):250-256
11. Castaldelli JM, Martins SS, Bhugra D et al. Does ragging play a role in medical
12. Lewinsohn PM, Hoberman HH, Rosenbaum M.A Perspective Study of Risk Factors
13. Mukhopodhyay P et al. Evaluation of Major Risk Factors related to Depression among
Medical Student NRS Medical College. International Journal of Medical Research and
14. Aniebue PN. Prevalence of depression among medical students in Nigerian university;
23(3), 459-466
56
17. Abiodun MG, Oluwafunto JS. Prevalence and Gender Difference in self-
18. Kwaku OA, Johnny AA. Prevalence and determinants of depressive symptoms
19. Othieno CJ, Okoth RO, Peltzer K, Pengpid S, Malla LO. Depression among
21. Inam SN, Saqib A, Alam E. Department of community health sciences Ziauddin
association 2002/2003;53(2)44-47
22. Afiong OO, Eme TO, Oboko OO, Bassey MI. Prevalence of Stress, Stressors
23. Rab F, Mamdou R, Nasir S. Rates of depression and anxiety among female
journal2008;14(1)126-133
57
25. Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y.Prevalence of depression,
2012;39(3);56-59
27. Nwobi EA, Ekwueme OC, Ezoeke UE. Mental Depression and Coping
of Medicine.2009;14(1), 23-31
28. Mane AB, Krishnakumar MK, Niranjan PC, Hiremath SG. Differences in
Diagnostic Research.2011;5(6);1228-1233
29. Mona S. Perception of stress and coping strategies by medical students at King
Sciences2014;9(1):30-35
www.unijos.edu.ng/the_university/history.phpAccessed 13.01.2015
31. Beck AT, Ward CH, Mendelsolson M, Mock J. An inventory for measuring
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33. Chen L, et al., Depression among Chinese Medical Students: Prevalence and
34. Yusoff MS, Abdulrahim AF, Baba AA, et al., Prevalence and Associated
35. Niemi PM, Vainiomaki PT. Medical students distress: quality, continuity and
59
APPENDIX
QUESTIONNAIRE
the above subject matter as part of the requirements for the award of MBBS
and we assure you that the information obtained will be confidential and will
1. Age (years)............................
3. Tribe..................................................................................
4. Religion
5. Level
6. Marital status
60
a) Single [ ] b) married [ ] c) separated [ ] d) divorced [ ] e) widowed [ ]
a) married with one wife [ ] b) married with more than one wife [ ] c) married
8. Family type
Complete this section by making a circle ‘O’ appropriately once for each
1. I feel sad
61
13. 0. I am not particularly discouraged about the future.
62
2. I expect to be punished.
1. I am disappointed in myself.
3. I hate myself.
1. I have thoughts of killing myself, but I would not carry them out.
3. I used to be able to cry, but now I can't cry even though I want to.
63
22. 0. I am no more irritated by things than I ever was.
25. 0. I don't feel that I look any worse than I used to.
unattractive.
64
26. 0. I can work about as well as before.
2. I wake up 1-2 hours earlier than usual and find it hard to get back to
sleep.
3. I wake up several hours earlier than I used to and cannot get back to
sleep.
65
30. 0. I haven't lost much weight, if any, lately.
Constipation.
2. I am very worried about physical problems and it's hard to think of much
else.
anything else.
DEPRESSION.
66
33. Have you lost someone close to you? Yes ( ) No ( )
35. With whom did you spend your childhood? Parents ( ) or Guidant ( )
49. Are you having any problem with your health? Yes ( ) No ( )
67
51. What do you do when you feel discouraged? a) Talk to someone ( ) b) watch
52. What do you do when you feel you are not living up to expectation? a) Talk to
others (specify)….......................................................................….
53. What do you do when you cannot sleep? a) Take sleeping pills ( ) b) do
54. What do you when you feel uncomfortable about your weight? a) Exercise (
Thank you for your cooperation, the information you have given will be kept
confidential.
68